Coronary arteries in crisscross heart. (1/5)

Crisscross heart, or superoinferior ventricles, is a complex and often confusing congenital anomaly. We report a heretofore unreported presentation of "isolated" crisscross heart in situs inversus levocardia, which allows us to more clearly define the typical features of crisscross ventricles. The case of this 41-year-old woman, who had a peculiar coronary anatomy, underscores the concept that coronary artery anatomy is strictly related to the myocardial mass served. In complex congenital heart defects, development of an anterior descending artery is possible (as a primary artery, along with the circumflex and right coronary arteries) only if the ventricular septum develops properly and is aligned with the semilunar valves. We use the present case of crisscross heart to illustrate the spectrum of anomalies that can occur during formation of the cardiac apex; this spectrum ranges from a normal apex, to a diverted apex (as in dextroversion in situs solitus), to a crisscross anomaly.  (+info)

Criss-cross heart: report of three cases with double-inlet ventricles diagnosed in utero. (2/5)

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Echocardiographic segmental analysis in patients with an atrioventricular criss-cross. (3/5)

The aim of this study was to describe the echocardiographic characteristics of patients with an atrioventricular criss-cross who underwent segmental cardiac morphological analysis. The study involved five patients with a criss-cross heart (0.6% of the studies). The patients' average age was 6 years and 3 months. All patients presented with situs solitus. Three had a discordant atrioventricular connection and two had a concordant connection. In addition, four patients had a ventriculoarterial connection with a double-outlet right ventricle while one had a concordant connection. Two patients had superior-inferior ventricles. Other associated lesions included ventricular septal defect in all patients, pulmonary stenosis, persistent ductus arteriosus and atrial septal defect in three, pulmonary perforation in one, and a hypoplastic aortic arch in one. In these patients, segmental analysis can be carried out satisfactorily using transthoracic echocardiography.  (+info)

Comparative value of transthoracic and transesophageal echocardiography in the assessment of congenital abnormalities of the atrioventricular junction. (4/5)

Information obtained from transthoracic and transesophageal echocardiography (two-dimensional echocardiography with spectral Doppler and color flow imaging) was compared in 17 patients with major congenital abnormalities of the atrioventricular (AV) junction (10 discordant AV connections, 1 criss-cross connection, 5 absent right connections and 1 absent left connection). The findings by either technique were correlated with findings at cardiac catheterization (12 patients) and at surgery (5 patients). In two of six patients with an absent AV connection as defined by transthoracic echocardiography, transesophageal imaging demonstrated an imperforate AV valve. In 11 of 11 patients with a discordant or criss-cross connection, assessment of AV valve and ventricular morphology (by defining the chordal attachments of both AV valves) was possible with transesophageal echocardiography (3 of 11 patients by transthoracic echocardiography); chordal straddling was detected in 1 patient and excluded in 3 others with an associated inlet ventricular septal defect. Anomalous pulmonary venous connection (one patient), atrial septal defect (three patients) and subpulmonary stenosis (five patients) were better assessed by transesophageal imaging, and atrial appendage morphology could be demonstrated in all. The transesophageal technique was less useful in demonstrating the anterior subaortic infundibulum or aortopulmonary shunt (two patients). Although systemic ventricular function could be assessed by either method with use of short-axis M-mode scans, transesophageal pulsed Doppler interrogation of AV valve and pulmonary venous flow patterns provided clues to diastolic dysfunction of the systemic ventricle.  (+info)

Criss-cross heart: report of two cases, anatomic and surgical description and literature review. (5/5)

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